Social care reform and the social care workforce, House of Commons, 18 March 2021

• COVID-19 has put adult social care firmly in the public, political and media spotlight. This emergency has highlighted the essential value of social care to the wider public and this interest needs to be harnessed in the debate about the future of care and support. Long-term reform is urgently needed and we are calling on the Government to set out its thinking at the earliest opportunity.
• Adult social care and support is a vital service in its own right. It helps people of all ages to live the life they want to lead. It binds our communities, helps sustain the NHS and provides essential economic value to our country. Too often health and social care are set on unequal footings, with the latter viewed (sometimes solely) in terms of the role it can play in supporting the former.
• Years of significant underfunding coupled with rising demand and costs for care and support have combined to push adult social care services to breaking point. Over the past decade, adult social care cost pressures have increased by £8.5 billion and total funding has increased by £2.4 billion. This meant a gap of £6.1 billion needed to be managed. Of this, £4.1 billion was managed through savings to the service, and £2.0 billion was managed through funding diverted from other services by cutting them faster than they otherwise would have been so that councils could fund adult social care. These pressures have been exacerbated by the response to COVID-19. We were therefore disappointed to see no mention of adult social care in the Government’s recent Budget.
• This underfunding puts the workforce and unpaid family carers under further strain, creating unmet and under-met need and impacting on social care’s ability to help mitigate demand pressures on the NHS.
• COVID-19 has clearly shown how important it is to have a highly skilled, well equipped, and supported care workforce which has parity of esteem with the NHS workforce. There needs to be tangible improvements in the pay of the adult social care workforce, potentially more in line with comparable roles in the NHS, as well as investment in training and workplace development and career progression. The LGA is calling on Government to establish an independent process to gather evidence and make recommendations as soon as possible so that planning for the future of pay and reward in adult social care can begin.

Years of significant underfunding, coupled with rising demand and costs for care and support, have combined to push adult social care services to breaking point. Over the past decade, adult social care cost pressures have increased by £8.5 billion and total funding has increased by £2.4 billion. This meant a gap of £6.1 billion needed to be managed. Of this, £4.1 billion was managed through savings to the service, and £2.0 billion was managed through funding diverted from other services by cutting them faster than otherwise would have been the case.

Councils are also facing significant extra costs from the demands created by COVID-19 as well as a significant loss of income. In relation to adult social care, councils are supporting care providers who face additional costs in ensuring continuity of care for those who rely on their support, as well as seeking to protect staff and the people they support from infection by COVID-19, and then providing care to those who fall ill with the virus.

The 2020 ADASS Budget Survey shows that the onset of the pandemic, and the additional financial and demand pressures faced by local authorities as a consequence, has led to a significant change in the Directors’ confidence in meeting their statutory duties relating to adult social care. For the current financial year (2020/21) only 4 per cent of Directors are fully confident that their budget will be sufficient to meet their statutory duties; this compares to 35 per cent in 2019/20.

The Health and Social Care Committee last year called for a £7 billion annual increase in adult social care funding by 2023/24 to cover demographic changes and uplift in staff pay in line with the national minimum wage, as well as funding to protect people who face catastrophic social care costs at a cost of £3.1 billion by 2023/24. LGA analysis, completed before the spending review, estimated an adult social care funding gap rising to £2.7 billion in 2023/24. Costs are considered in terms of core pressures (demography and inflation), the provider market gap (the difference between what providers say is the cost of delivering care and what councils pay), and assumptions are also made about the path of future funding (including council tax and core grant rising in line with inflation). The LGA will be publishing new analysis on the funding gap facing local government later this year.

One of the only positives to come out of COVID-19 is that it has put adult social care firmly in the public, political and media spotlight. It has also shone an important light on the tireless work of our invaluable social care workforce who are providing care and support to all who need it in the most challenging of circumstances. This emergency has begun to highlight the essential value of social care in its own right to the wider public and this debate needs to be harnessed as we think about the future of care and support.

The legacy of COVID-19 for social care – and most importantly the people who use social care services – must be a reset, not simply a restart. This impetus should spur our thinking around long-term reform of care and support, which we have always said should be built on cross-party cooperation. We are committed to working with Government and all parts of the social care world – particularly people with lived experience – on a way forward that is informed by the many valuable lessons from the response to COVID-19 on the role and value of social care in all our lives.

The LGA has published seven principles for reform of adult social care, which chart a way forward for ensuring the very best local care and support in the future, so that people can live their very best life. Several prominent organisations have signed up to these principles.

The White Paper’s recognition of the pressures facing social care, and a restated commitment to reform, are welcome. But the proposals do not address the urgent need to put social care on a sustainable, long-term financial footing. It is disappointing that the Government’s immediate priority for social care is to strengthen national oversight of care and support, rather than bring forward its long-awaited wider funding reforms to support people of all ages to live the life they want to lead. We were also disappointed to see no mention of adult social care in the recent Budget. Government should commit to publishing at the earliest opportunity a timetable for producing its proposals on the future of adult social care and support.

It is important to note that the White Paper contains many proposals on adult social care and public health that, prior to its release, had not been in the public domain. It is essential that Government commits to an inclusive consultation and engagement on any proposals that have not previously been in the public domain. These changes will impact some of the core functions of local government, so it is crucial the sector is fully engaged.

The White Paper also announced the Government’s intention to work with councils and the social care sector to enhance existing assurance frameworks that support the drive to improve the outcomes and experiences of people and their families in accessing high quality care and support. We understand Government’s desire for greater transparency in social care. Councils need to be an equal partner in the design of any national oversight, which must build on existing sector led improvement work (which will necessarily continue to evolve to reflect local/national priorities), recognise local democratic accountability and give a meaningful voice to people who draw on and work in social care.

Any new processes or structures for assurance and oversight need to be accompanied by a New Burdens assessment to fairly capture the capacity and resource implications for councils in meeting new regulatory approaches. This would also need to consider CQC’s capacity and skillset.

Any assurance process has the potential to highlight shortfalls in services and delivery of the intentions of the Care Act due to resource constraints. Any assessment of a council’s adult social care services would need to be contextualised in terms of available resources.

The assurance process must be developed in partnership with local government and the CQC; we would favour a review-driven approach looking at whole systems, based on a shared agreement of: what good looks like – in particular, the importance of person-centred and locally flexible care and support; and the criteria for where greater intervention might happen

We need to avoid an Ofsted-style system in which a wide range of data is boiled down to a single judgement, leading to ratings and league tables.

One of the LGA’s seven principles for adult social care reform is that the Government should commit to a new deal for the care workforce, comprising action on pay, training and development, career progression and professionalisation, and recognition.

There are on-going recruitment and retention problems highlighted in high vacancy and turnover rates that affect service quality. In addition, many staff have uncertain incomes because of the prevalence of zero-hours contracts. The temporary shifts in these patterns due to COVID-19 have highlighted the need to deal with them permanently. A recent Skills for Care report on ‘the state of the social care market’ found:

• Pay in adult social care is on average 25 per cent lower than pay in the NHS.
• The adult social care sector in England still needs to fill around 112,000 job vacancies on any given day.
• The staff turnover rate of directly employed staff working in the adult social care sector was 30.4 per cent in 2019/20.

The ability to attract and retain staff with the highest skills sets is hampered by poor perceptions of pay and reward and the lack of coherent career structures that allow people to think beyond temporary work in social care. Better pay and reward needs to form part of a package of reforms to transform the sector as set out for example in the recent strategic workforce framework by the LGA, ADASS and Skills for Care. Increased investment in training and development, the use of technology and a focus on the wellbeing of staff will all help to drive improved productivity across the sector alongside improved pay and conditions.

The social care workforce must be developed in a manner equivalent to the NHS as part of a stable, sustainable solution to long-term funding problems and that this must involve “parity of esteem” for social care staff with their NHS colleagues. Any changes to pay and reward must be fully funded by central Government as there is no resource in the sector to meet the demands of this challenge.

The Government should establish an independent process to gather evidence and make recommendations on the level and future determination of social care pay as soon as possible so that planning can begin. The transformation of pay and reward is a complex medium to long-term proposition and will require considerable investment. Moreover, there will be a variety of opinions on the best way to take things forward. An independent process provides the best opportunity to achieve a consensus on outcomes. Other terms and conditions should be looked at as soon as possible.

It is vital that we think and talk about adult social care as an economic opportunity rather an economic cost.  Reforming pay and reward for those working in adult social care pay will attract people to work in the sector, fill existing vacancies and ultimately benefit local economies. The Resolution Foundation calculated that if a living wage for care workers was publicly funded, just under half (47 per cent) of public costs would be returned to the Exchequer through higher personal tax receipts and lower benefit payments. The overall economic contribution of adult social care is considerable, as estimates produced for Skills for care and the LGA show. At the time of the report, adult social care contributed £46.2 billion to the economy on an annual basis and supported 603,000 jobs through indirect spending as well as the 1,200,000 employed directly in the sector. Adult social care can play an important role in supporting the country and the economy as we seek to recover from the effects of the pandemic. 

The adult social care system could not survive without the contribution of unpaid carers, who provide vital support for thousands of people every day. Councils fully recognise their crucial role and assess and support hundreds of thousands of carers every year but could do even more with the right resources.

A recent report found that the 2014 Care Act’s strengthening of carers’ rights did not improve their access to support because of council budget pressures. Every part of the care and support sector is under intense pressure due to the pandemic and councils are doing all they can to support carers and those they care for.

Caring can place a real strain on carers – emotionally, physically and financially. COVID-19 has further highlighted the incredibly valuable role played by unpaid carers and the difficult circumstances they face. An estimated 4.5 additional people have become unpaid carers because of the pandemic. This is on top of the 9.1 million unpaid carers already caring before COVID-19 with many juggling their own health and wellbeing issues and employment.

Jade Hall, Public Affairs and Campaigns Adviser

[email protected]